Malaria still a ‘disturbing’ health issue

According to Ngozi Okonjo-Iweala (NOI) Polls, almost seven in 10 Nigerians had malaria, at least once, in the past year. How can Nigeria combat this worrisome health issue? OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU report.

Despite efforts to stop the disease, malaria is still ravaging the land. The three tiers of government appear unable to tame the monster, which has since been caged in some other parts of the world.

The World Malaria Day was marked on April 16, but the event virtually went unsung in Nigeria. Under the Millennium Development Goals (MDGs), the disease is expected to be eradicated by 2015.

Can Nigeria attain the goal? It is in a bid to do so that the Federal Government adopted programmes such as Roll Back Malaria, free distribution of Insecticide Treated Nets (ITNs) and Long Lasting Insecticide Treated Nets (LLINs), Indoor Residual Spraying (IRS) with insecticides. Promotion of clean environment and introduction of affordable malaria medicine are a few of the other interventions the three tiers of government have deployed to end the disease.

Most of these interventions have either been wishy washy in implementation or the governed sabotaged through sheer ignorance.

For instance, the Federal Goverment provided for the availability of artemisinin combination therapy (ACT), which is the World Health Organisation’s (WHO’s) recommended anti-malaria first line drug, but to get same is a major task because it is not readily available on the counters, despite being classified as over the counter medicines (OTC). And where they are available, they do not go for the official price. In principle, the drugs have been fixed for N270 but in implementation they are sold for N600 and above.

Mr Seyi Oluwasegun, a businessman, took his two year-old son to a primary health care centre at Ipaja, a Lagos suburb, for treatment. He was asked by the health personnel to take the child to a laboratory for a diagnostic test. He obliged. When he returned he was given a prescription to purchase a malaria drug. He protested and stated that the state government did provide free drugs for children under five years and adults above 65 years, but he was told there was no longer stock of anti-malaria drugs.

Frustrated, he went to a nearby pharmacy outside the hospital, where he bought the drug for N650.

He is not alone. Another patient, Pa Joseph Oshaye, a 72-year old retiree, said he had to pay through his nose to treat the ailment when he was diagnosed for the same disease at another government hospital. He too obtained his drugs in a private pharmacy.

He lamented that in the past, N20 worth of Chloroquine would have been sufficient to treat the disease but it is no longer the drug of choice. So he had to spend N1, 400 to treat himself after the disease had been diagnosed. The first time he took the drug he didn’t feel any relief and he was advised by a community nurse to treat it with another drug. He said he suspected that the first drug, which he bought, might be a fake. This time around he left his environment to look for another pharmacy where he paid N700 for the drug. After about two hours he felt better. He said: “Treating malaria is no longer cheap as the Federal and state governments promised.”

Investigations revealed that a patient would need about N650 to treat the disease. Some patients said they were asked to go for a test as a form of diagnosis before they can commence treatment. They said the cost of test alone is high let alone that of the drug.

Yet, Health Minister Prof Onyebuchi Chukwu, said the Federal Government has subsidised the cost of malaria drug because of the peculiarity of the disease.

Chukwu, who spoke in Lagos, said people should not patronise health facilities who charge above the required amount of N300 for an artemisinin combination therapy (ACT) anti-malaria drug. He said such cases should also be reported to the Federal Ministry of Health for the appropriate action. But who will bell the cat. And if done, would the authority take appropriate sanctions against offenders. The ostrich game is it.

The reality is that malaria drugs are sold at exorbitant prices because of the disease burden. Malaria is about the most common of all the fevers. According to the opinion poll by a leading opinion polling and research organisation, NOI Polls Limited, 44 per cent of Nigerians visit hospitals when they have malaria, 38 per cent simply buy medicine from pharmacies or ‘chemists’, 13 per cent simply make use of native herbs like neem leaves (dongoyaro), lemon grass leaves or other form of herbal concoctions.

According to the poll, respondents were asked how many times they had malaria in the last 12 months, to which majority of respondents (66 per cent: 26 per cent +19 per cent + 10 per cent +five per cent +sic per cent) said they have been infected with at least once over the past one year, while 34 per cent of respondents said they have not had malaria in the past 12 months.

Further analysis by geo-political zones showed that malaria is more prevalent in South than in the North. results showed that majority of the residents in the Northern regions: North-Central (43 per cent), North-East (38 per cent), and North-West 38 per cent have not had malaria pver the past twelve months. While the Sothern Regions:South-south (77 per cent0, south-East (75 per cent) and South-west (64 per cent) have the largest per centage of the respondents who had malaria more than once over the last twelve months.

This disparity between geo-political zones is perhaps due to the greater presence of rivers, seas, and lakes in the south where mosquitoes are prevalent; while the North is mostly land locked.

To how people treat malaria when infected, nationwide results showed that majority (44 per cent) of the respondents visit the hospital to see a doctor when they have malaria. This is followed by 38 per cent who simply buy medicine from the pharmacy or chemist. Furthermore, 13 per cent said they make use of native herbs, such as Neems (dogonyaro), lemon grass leaves or other form of herbal concoctions. The Poll concluded that majority of the residents in the Southern regions self-medicate, unlike the Northern regions that go to the hospital.

Yet the Health Minister, Prof Onyebuchi Chukwu said the Economic Community of West African States (ECOWAS) has encouraged member countries to ensure vector control through Integrated Vector Management in addition to implementing large scale larviciding.

Chukwu, who spoke at the African Union Conference of Health Ministers in Addis Ababa, Ethiopia, said a ground breaking ceremony for Larviciding Factory was done in Nigeria a couple of months ago in the presence of the President and Vice-President of ECOWAS Commission and the Deputy Prime Minister of Venezuela.

“The region is also focusing on vector resistance and drug surveillance. Africa must employ Indoor Residual Spraying (IRS) with DDT. There is also a need for scale up of the use of rapid Diagnostic Test Kits (RTDs),” he stated.

Commissioner of Health, Lagos State, Dr Jide Idris said the government has the political will and commitment to ensure wholly free health care delivery for under five and adult from 65 but funding is the problem.

He said this was why the government is placing emphasis on payment of taxes so that it can serve the people better, especially in the area of health care for the two categories of people in the society.

He said in Lagos State, only 17 per cent of the 88 per cent of the people it gave the Long Lasting Insecticide Nets (LLINs) were using them. This, he said, was according to a recent survey it conducted.

Dr Idris urged residents not to keep the nets but rather should use them to prevent malaria. Idris, who spoke to reporters on the occasion of World Malaria Day (WMD), said some households have converted the nets to fishing nets, to catch fish while others have been using them for other unacceptable reasons.

The theme, which was adopted by the World Health Organisation (WHO) for the next three years, is-Invest in the future: defeat malaria. Its slogan: Time is now. He said the disease, which is responsible for 60 per cent of out-patients attendance to health facilities was still prevalent in the state because of its coastal nature.

Idris called for effective diagnosis before treatment, stressing that it is not all fevers that could be regarded as malaria.

“Lagos has collaborated with its partners to ensure that microscopes and Rapid Diagnostic Test (RTD) kits are provided while Artemisinin Combination Therapy (ACT) anti-malaria drugs are given free for treatment in its facilities,” he said.

Private organisations are not left out in the fight to end the disease. For instance, Ogun State government and Reckitt Benckiser’s Mortein insecticide brand has called for an all-inclusive strategy to bring down the current malaria prevalence in Nigeria and African at large.

They lamented that although malaria was preventable; there was need for concerned stakeholders to take proactive steps to stop the current trend of avoidable deaths resulting from the disease, especially among expectant mothers and under five children.

The Commissioner of Health, Dr Olaokun Soyinka, said because of the strategic placement of Africa as the new hub for the world’s economy, it was imperative to accord malaria eradication priority and every support needed to overcome the alarming prevalence rate.

Soyinka described the initiative as a demonstration of responsible corporate citizenship which he said underpinned the company’s love and commitment not only to the people of the state, but to Nigeria as a whole.

He said: ‘‘Complementary efforts of this nature are not only needed but deeply appreciated by the government of Ogun State. This will certainly go a long way in ensuring that our children and mothers are free from the scourge of malaria.’’

East) Africa, Reckitt Benckiser, Mr Ashok Bashin, said the need to fill the ‘‘deadly gaps’’ in the various malaria eradication programmes informed the intervention initiative being provided by the company.

“There are lots of activities and momentum to combat malaria in Nigeria, but deadly gaps still exist. More needs to be done to prevent children from being infected and ensure access to quality malaria treatment”, he declared.

Ashok said: ‘‘empowering families and communities through participation – while improving their knowledge about how to prevent, recognize and treat malaria – is an important part of Reckitt Benckiser’s malaria prevention work.

‘’Community workers should try to sensitize the local population about preventing malaria through the use of insecticide-treated nets (ITNs), cleaning their environment on regular basis, avoidance of stagnant water in their surroundings and use of insecticides like Mortein which is safe on both the mother and child.’’